When primary-aged pupils self-harm

Written by: HTU | Published:

Self-harm, traditionally seen as a teenage issue, is becoming increasingly common among primary-age children. Headteacher Update looks at how schools are coping

On Samantha’s arm there were scratches. She admitted that she had taken a pencil sharpener apart and used the blade. What she couldn’t do was tell her mum and headteacher why.

This is just one example of an increasing number of incidents in primary schools of children self-harming. It is a worrying and baffling problem that can leave headteachers and designated members of staff unsure what to do.

Self-harm is usually associated with adolescents and young people rather than primary-age children. “It’s an expression of feeling, different to that of the adolescent,” explained Dr Trisha Waters. “It’s more likely to appear as head-banging, scratching and hair pulling than the more pre-meditated cutting.”

Dr Waters is director of the Centre for Therapeutic Storywriting and gives an example from the Story Links training programme of a seven-year-old boy, Fred. His behaviour in school included banging his head on the desk, punching himself and threatening to kill himself by jumping off the top of the climbing apparatus. In Fred’s case the reasons for the behaviour began to unravel during the Story Links sessions.

Dr Waters continued: “These children are not at the abstract thinking level, they don’t usually disguise their self-harm, which is often linked to difficulties around attachment and relationships.”

Faced with such behaviour, it can be difficult to know what to do next. Samantha’s headteacher felt she was in new territory. She told Headteacher Update: “It didn’t seem to fall into any of the usual categories of behaviour we’re used to dealing with.”

Already having a good relationship with mum, the school decided to contact her to find out if she was aware of the behaviour and if it was happening at home.“We felt that we needed to explore Samantha’s actions with mum first. But we were also alert to the fact that this behaviour could be linked to events at home.”

What the school did feel was missing was any kind of support or information from the usual services: “I think if we had been a secondary school it might have been different, but there was a kind of vacuum of advice around the issue in primary schools.”

In the end they came to the conclusion that Samantha’s behaviour needed to be addressed from several different angles.

“She did have difficulties with relationships in school and although we weren’t aware of there being any bullying she did not have a strong circle of friends to draw on.“We have a nurture group and Samantha spent some time there, where she made more friends across the school. We continued with regular meetings with mum and discussed the issue with our educational psychologist.

“Samantha’s youngest brother was causing problems at the time and it seemed as though this was Samantha’s way of dealing with it.”



The underlying reasons

One of the reasons it is so difficult to know how to proceed is that self-harm can be caused by a number of different factors.

Domestic violence in the home, anxiety and depression among family members as well as being subject to physical or mental abuse can all lead to pupils, even young pupils, finding an outlet for their feelings in physical pain.

One study has looked at the link between bullying in primary school and later self-harm in secondary school. The study, Bullying Victimisation and Risk of Self-harm in Early Adolescence, found that of 62 children, all aged 12, who had self-harmed, more than half were victims of frequent bullying.

However, more often than not, for young self-harmers, relationships in the family are at the route of the problem. Dr Waters described how this was the issue for Fred: “He did not have any contact with his biological father and his step-father was a Black African. There had been a racist incident at the childminder’s and this had really upset him. It was the anxiety around his relationship with father figures that seemed to be the cause of his behaviour.”

In Samantha’s case the school felt confident that they could address the issue openly with mum. However, there may be cases where contact with family has already presented difficulties and the relationship is fragile. Schools can feel anxious about whether a referral to social care should be made or not.

Dr Louise Richards, a consultant child and adolescent psychiatrist, suggests that self-harm in a young child might be a result of witnessing another member of the household self-harming. She added: “There might be a communication problem at home. It is important to speak to the parents to explore why this might be happening. A referral to social care could be required in some cases but it shouldn’t be the automatic route to take.”



What schools can do

Dr Richards advises that the school might take two immediate routes: “You should make a referral to CAMHS and ask the parents to take the child to see their GP. The advantage of the GP is that they will see the child on their own and ensure that there are no suicidal tendencies.

“CAMHS will bring in the family for a discussion. It is ideal if the whole family attends, but it is rare that it happens that way. It is a case of getting to know what’s going on, the ‘story’ of the family. Often it’s an extreme life event coupled with a communication difficulty. Once you’ve found the explanation it can often be put right.”

Schools should look at the support and strategies they can provide themselves while a referral is being made.

It is ideal if you have a learning mentor or other key individual who has the time and capacity to make themselves available. A therapeutic approach like Story Links, can help support the emotional needs of the child in an unthreatening way.

It is important to take a non-judgemental approach to the self-harm and not appear shocked. This can be difficult and focusing on the feelings of the child can help. How do they feel? Do they have any worries they would like to talk about? What helps them not hurt themselves?

One action that all schools can take is finding ways through their curriculum to increase pupils’ resilience. Having an open environment in which difficulties and worries can be discussed in a supportive and unthreatening way is vital, not only for dealing with self-harm but many of the other mental difficulties that even very young children can find themselves suffering from.

Activities that enable pupils to raise their self-esteem and feelings of self-worth will benefit everyone.



Conclusion

“I think we might have still taken the same actions, but we could have done so more confidently if we’d known who to turn to,” Samantha’s headteacher said.

“When services are stretched you are conscious of the time-lapse there might be if you approach the wrong one. It can feel like everyone is passing the buck. No-one wants to take it on as their responsibility as they know a workload will follow.”

What is evident is that primary schools, like Samantha’s, need the information and support to be able to deal with self-harm when it occurs. Unfortunately, the increasing pressures on families in times of austerity mean that more Samanthas and Freds are likely to need help in our primary schools.



Further information
• Story Links: www.storylinkstraining.co.uk.
• Young Minds: www.youngminds.org.uk.
• Bullying Victimisation and Risk of Self-harm in Early Adolescence (a longitudinal cohort study): www.bmj.com/content/344/bmj.e2683.


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